To the Editor.—
I read with interest the article "Reversal of Intractable Pericarditis by Triamcinolone Hexacetonide" in the Archives, by Fuller et al (136:979-982, 1976). As the authors mention, I have been interested in this problem for a number of years since we began using the therapy in 1971. The authors' experience confirms the impression that there are two forms of uremic pericarditis (ie, those that do respond to dialysis or better control of uremia and those that are more intractable and usually do not respond to dialytic therapy). Their evidence of this intractability in the face of intensive dialysis and indomethacin therapy is indisputable, as is their evidence that the patients did respond to drainage and the local instillation of triamcinolone hexacetonide. It was encouraging to me to see another large university center using this type of therapy as an alternative to the more inconvenient pericardiectomy or pericardial fenestration.